IN THE DELAWARE MUNICIPAL COURT ... - City of Delaware
IN THE DELAWARE MUNICIPAL COURT ... - City of Delaware
IN THE DELAWARE MUNICIPAL COURT ... - City of Delaware
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<strong>IN</strong> <strong>THE</strong> <strong>DELAWARE</strong> <strong>MUNICIPAL</strong> <strong>COURT</strong>, <strong>DELAWARE</strong> COUNTY, OHIO<br />
70 North Union Street, <strong>Delaware</strong>, Ohio 43015 ! Voice: 740.203.1560 ! Facsimile: 740.203.1599 ! www.municipalcourt.org<br />
State <strong>of</strong> Ohio<br />
Registrar, OBMV<br />
Respondent<br />
vs.<br />
adv.<br />
full name, please print<br />
address<br />
city, state zip<br />
email<br />
Petitioner - Appellant - Defendant<br />
CASE NO:<br />
court number only<br />
Petition Regarding Driving Privilege<br />
Suspension imposed by OBMV<br />
one> this case is [ ] new civil [ ]existing Crim-Traf (4510.73)<br />
CV • 12pt. Suspension - Appeal and / or Driving Privileges<br />
CV • Noncompliance Suspension - Driving Privileges (2+ w/in 5yrs)<br />
CV • Reinstatement Fee - Pay Plan or Driving Privileges<br />
CV • Foreign Jurisdiction OVI-Drug Offense Susp. - Driving Privileges<br />
CV • Other Appeals/Petitions<br />
TRCR • Other Appeal/Petition re OBMV Suspension<br />
TRCR • Suspension by this Court Concurrent with OBMV Suspension<br />
1. A. Petitioner received driving privilege suspension notice from the Ohio Bureau <strong>of</strong> the Motor Vehicles (OBMV) due to<br />
[check applicable field(s)] [ ]accumulation <strong>of</strong> points [ ]failure to show pro<strong>of</strong> <strong>of</strong> financial responsibility [ ] suspension <strong>of</strong><br />
privileges by foreign jurisdiction for drug or OVI <strong>of</strong>fense [ ]pending payment <strong>of</strong> reinstatement fees required under R.C. §§<br />
4507.1612, 4507.45, 4509.101, 4509.81, 4511.191, or 4511.951 [ ]other<br />
B. A copy <strong>of</strong> Petitioner’s OBMV driving record is attached [failure to attach may delay processing this petition].<br />
C. The beginning date(s) <strong>of</strong> the suspension(s) is / are / was: .<br />
D. Petitioner presently maintains pro<strong>of</strong> <strong>of</strong> financial responsibility, a copy <strong>of</strong> which is attached [except, in 12 point suspension<br />
and reinstatement fee deferral/payment plan petitions that do not seek driving privileges, and Administrative Appeals].<br />
E. Petitioner certifies that all information provided on this petition and any attachment is true and accurate.<br />
F. Unpaid reinstatement fees currently due to OBMV total $ [if requesting payment plan or delay].<br />
[Check one or more <strong>of</strong> the following sections that apply. Checking inapplicable sections will delay processing <strong>of</strong> the petition.]<br />
[ ]2. 12 Point Suspension Appeal R.C. § 4510.037(B). A. This petition is filed BEFORE the effective date <strong>of</strong> suspension.<br />
B. Petitioner can show cause why the suspension <strong>of</strong> driving privileges should be set aside.<br />
C. For reasons to be shown at the hearing, Petitioner requests an order vacating the Registrar’s determination <strong>of</strong> accumulation<br />
<strong>of</strong> excess points and resulting imposition <strong>of</strong> suspension. [Oral hearing required.]<br />
[ ]3. 12 Point Suspension - Request for Driving Privileges R.C. § 4510.037(G). Petitioner appeals imposition <strong>of</strong> the<br />
suspension only for the purpose <strong>of</strong> requesting driving privileges as set forth on the attached Driving Privileges Request Supplement.<br />
[Privileges can be granted without oral hearing. Suspension is stayed only if appeal filed before suspension begins.]<br />
[ ]4. Noncompliance Suspension R.C. § 4509.101. A. Petitioner has complied with R.C. § 4509.101(A)(5) by submitting to<br />
the Ohio Bureau <strong>of</strong> the Motor Vehicles all <strong>of</strong> the following, where applicable:<br />
i. Financial responsibility reinstatement fee (copy <strong>of</strong> OBMV receipt attached).<br />
ii. Financial responsibility nonvoluntary compliance fee, if applicable (copy <strong>of</strong> OBMV receipt attached).<br />
iii. Pro<strong>of</strong> <strong>of</strong> financial responsibility - SR22 (copy attached).<br />
B. Petitioner requests limited driving privileges as detailed on the attached Driving Privileges Request Supplement and as<br />
st<br />
allowed by law. (On 1 suspension in 5 yrs, OBMV will restore privileges on payment <strong>of</strong> reinstatement fee and pro<strong>of</strong> <strong>of</strong> insurance.<br />
nd<br />
st<br />
Court privileges are prohibited during the first 15 days <strong>of</strong> 2 noncompliance suspension w/in 5yrs <strong>of</strong> violation, and 1 30 days if<br />
there are two or more prior noncompliance suspensions within 5yrs <strong>of</strong> violation).<br />
[ ]5. Foreign Jurisdiction Suspension. R.C. § 4510.17(E). Due to OVI or drug suspension by a foreign jurisdiction, the<br />
OBMV imposed a suspension which will seriously affect Petitioner’s ability to continue employment. Petitioner requests work<br />
related driving privileges during the suspension <strong>of</strong> Ohio driving privileges.<br />
[ ]6. Other Appeal or Petition. R.C. § 4510.73 (fully explain, use additional sheets if necessary).<br />
Petition Regarding OBMV Imposed Driving Privilege Suspension
[ ]7. Plan or Delay to Pay Reinstatement Fees. R.C. § 4510.10. Petitioner cannot reasonably pay reinstatement fees as shown<br />
at 1(F) now due on the suspension(s) now in effect or about to begin; but for said fee(s) and any other suspension above mentioned,<br />
Petitioner would be eligible to operate a vehicle or obtain reinstatement <strong>of</strong> operating privileges in Ohio. Pro<strong>of</strong> <strong>of</strong> financial<br />
responsibility and a copy <strong>of</strong> Petitioner’s OBMV driving record are attached. Petitioner requests limited driving privileges shown<br />
on the attached Driving Privileges Request Supplement and as otherwise allowed by law. (Before filing this application, Petitioner<br />
should investigate eligibility for OBMV Fee Installment Plan (BMV Form 1152) which requires no filing fee and restores unlimited<br />
driving privileges.) Pending full payment <strong>of</strong> all reinstatement fees due, Petitioner requests [CHECK ONLY ONE]:<br />
A. [ ] A reasonable payment plan not less than $50 per month payable to the OBMV until all reinstatement fees are paid in<br />
full. R.C. § 4510.10(D)(1). (Monthly payments required to maintain limited driving privileges.)<br />
B. [ ] A payment delay not longer than 180 days at the end <strong>of</strong> which full payment <strong>of</strong> all reinstatement fees must be made to<br />
the OBMV in order to maintain or recover driving privileges (no payments required during delay period). (NO FUR<strong>THE</strong>R DELAY<br />
IS PERMITTED. LIMITED PRIVILEGES EXPIRE AT END OF <strong>THE</strong> DELAY PERIOD PEND<strong>IN</strong>G PAYMENT OF ALL FEES<br />
DUE.) R.C. § 4510.10(D)(2).<br />
8. Wherefore, Petitioner requests that the court grant the relief above requested. If this is a traffic or criminal case and the<br />
court imposed a license suspension, Petitioner seeks driving privileges during the court suspension. Petitioner acknowledges that<br />
the clerk and court personnel cannot give legal advice and no information provided has been taken as such. Petitioner acknowledges<br />
that this form is provided as a convenience; nothing in the form constitutes legal advice. [Court cost deposits, where required, are<br />
not refundable if the court denies relief requested. For legal advice Petitioner must contact an attorney.]<br />
9. Precipe for Service [in new civil case only]. Petitioner requests that the clerk serve a copy here<strong>of</strong> on Respondent by<br />
regular mail and on the <strong>Delaware</strong> <strong>City</strong> Prosecutor by leaving a copy here<strong>of</strong> in the Prosecutor’s box at the court.<br />
signature <strong>of</strong> [ ]petitioner<br />
[ ]attorney for petitioner<br />
print name <strong>of</strong> attorney for petitioner (if filed by atty.)<br />
SCR#<br />
petitioner phone number<br />
XXX-XXpetitioner<br />
OL# SSN DOB<br />
[petition may be delayed/denied if identifying data is incomplete.]<br />
address (<strong>of</strong> atty, if filed by atty.)<br />
<strong>City</strong>, State Zip<br />
phone<br />
[Proper service must be shown. Only one signature required.]<br />
10. I served a copy here<strong>of</strong> by [ ] placing copy in the <strong>City</strong> Prosecutor’s court mail box. [ ] regular U.S. mail.<br />
A. Return <strong>of</strong> Service - [use in new civil case] B. Certificate <strong>of</strong> Service [use in existing Traffic/Criminal Case]<br />
Cindy Dinovo, Clerk <strong>of</strong> Court<br />
by:<br />
Deputy Clerk [ ]Petitioner [ ]Attorney for Petitioner<br />
WebCV Driv Priv Omnibus Pet FITB 2013.pet.wpd0224151432 ©2013 K. Pelanda Ver 24Feb15<br />
11. The following documentation must be submitted in order to avoid processing delays and/or dismissal <strong>of</strong> the petition.<br />
A. All petitions require the following:<br />
i. [ ] OBMV Driving Record (DR), either <strong>of</strong> the following<br />
(must show applicable active and future suspensions, if any):<br />
a. <strong>of</strong>ficial abstract from OBMV.<br />
b. n<strong>of</strong>ficial driving record from www.bmv.ohio.gov (click<br />
‘online services’ then ‘view driving record.’)<br />
ii. [ ] Notice <strong>of</strong> Suspension (if details are not shown in DR)<br />
iii.[ ] Pro<strong>of</strong> <strong>of</strong> financial responsibility currently in force -<br />
SR22 (if driving privileges requested), unless DR shows filed.<br />
iv.[ ] Driving Privileges Request Supplement (if driving<br />
privileges requested).<br />
B. With the following, the petition must also include:<br />
i. Noncompliance suspension petitions:<br />
a. [ ] OBMV nonvoluntary compliance fee receipt,<br />
if applicable, unless DR shows paid.<br />
b. [ ] OBMV reinstatement fee receipt , Unless DR<br />
shows paid.<br />
ii. Reinstatement fee deferral / pay plan petitions:<br />
[ ] OBMV nonvoluntary compliance fee receipt, if applicable,<br />
unless DR shows paid.<br />
2<br />
Petition Regarding OBMV Imposed Driving Privilege Suspension
<strong>IN</strong> <strong>THE</strong> <strong>DELAWARE</strong> <strong>MUNICIPAL</strong> <strong>COURT</strong>, <strong>DELAWARE</strong> COUNTY, OHIO<br />
70 North Union Street, <strong>Delaware</strong>, Ohio 43015 ! Voice: 740.203.1560 ! Facsimile: 740.203.1599 ! www.municipalcourt.org<br />
Driving Privileges Request Supplement For Use with Separate Petition/Appeal Regarding Driving Privileges<br />
1. Petitioner name: DOB Case No. .<br />
2. OL# Issuing state Expiration date SS# XXX - XX -<br />
3. Begin & end date(s) <strong>of</strong> suspension(s) per OBMV notice(s): Begin , End .<br />
4. Are you aware <strong>of</strong> any other suspension <strong>of</strong> your driving privileges (if yes, describe in 6.)? [circle one]. Yes No<br />
st<br />
5. Employer / School information: 1 Employer / school 2d Employer / school<br />
A. Name. . . . . . . . . . . . . . . . . . . . . . . .<br />
B. Street Address.. . . . . . . . . . . . . . . . .<br />
C. <strong>City</strong>, State Zip.. . . . . . . . . . . . . . . . .<br />
D. Employer/ School Telephone. . . . . .<br />
E. Work address if different from above<br />
(for multiple work sites use 6). . . . . . .<br />
F. Work days & hours EXCLUD<strong>IN</strong>G<br />
COMMUTE TIME. Excessive hours or<br />
failure to provide hours will lead to delay<br />
or denial <strong>of</strong> application. Explain at E if<br />
hours are more than 10hrs/day or 50<br />
hrs/week.<br />
[ ] Check if on-call during other hours.<br />
Explain below at 6.<br />
G. Commuting distance and time. . . . .<br />
6. Other<br />
( )<br />
From To<br />
Mon M M<br />
Tues M M<br />
Wed M M<br />
Thur M M<br />
Fri M M<br />
Sat M M<br />
Sun M M<br />
Dist. Miles Min’s.<br />
( )<br />
From To<br />
Mon M M<br />
Tues M M<br />
Wed M M<br />
Thur M M<br />
Fri M M<br />
Sat M M<br />
Sun M M<br />
Dist. Miles Min’s.<br />
7. [ ]Petitioner /Atty. will pick up entry. Entry will be sent by email/mail unless this box is checked.<br />
The undersigned confirms that the above information is true and complete.<br />
X<br />
Signature <strong>of</strong> Petitioner Not required if filed by Atty.<br />
WebCV Driv Priv Omnibus Pet FITB 2013.pet.wpd0224151432<br />
©2012 K. Pelanda Ver 21Feb12<br />
X<br />
Attorney for Petitioner if filed by attorney)<br />
Print name <strong>of</strong> attorney for Petitioner if filed by attorney.<br />
SCN<br />
Petition Regarding OBMV Imposed Driving Privilege Suspension